Reproductive Biology Lessons for the Politically Active

As a public service in this election season, I am happy to clarify a few reproductive biology facts that many social conservatives (e.g. Representative Todd Aiken) seem to have forgotten, never learned or perhaps have willfully ignored.

1.Women do not have a magic vagina to ward off attacking sperm from a rapist. If we had one, we would surely repel the entire rapist, not just his sperm. John Stewart of the Daily Show fully explores the concept of the magic vagina espoused by Rep. Aiken with the derision it so richly deserves. Honestly, sometimes humor is the only thing that keeps me from banging my head against a wall in frustration in these last weeks leading up to the 2012 election.

2. Some GOP conservatives think that rape is unlikely to result in pregnancy so obviously a “raped” pregnant woman is lying about her rape. That is certainly a convenient belief to justify making all abortion illegal. However, the reproductive facts do not agree. Rape has a pretty good chance of causing pregnancy because rapists tend to target younger women in their prime reproductive years. In fact, approximately 5% of rapes cause pregnancy, producing about 32,000 US pregnancies each year. Additionally, there is some physiological evidence that the stress of rape may actually induce ovulation in some women. Other animals have coitus- induced ovulation so this is not as wild as it seems. Another possible mechanism for coitus-induced ovulation in many species is the existence of an ovulation inducing factor (OIF) in seminal fluid. Whether this mechanism exists in humans is still unclear, but shared gene sequences for this factor have been found in humans.

3. Not all embryos become persons. Most embryos, at least in the IVF lab, are “failed experiments” in the sense that they might theoretically have had the potential to become persons but they couldn’t become a person because something was missing, either inside the embryo (genetic or metabolic problems) or inside the woman (uterine problems). In every program I have worked in, almost every woman who went through IVF had an embryo transfer but at best, only 65% became pregnant and a percentage of those pregnancies were lost, resulting in a take home baby rate of about 50%. A 50% take-home baby rate is good by national standards but is irrefutable evidence that not all transferred embryos become people. Many other embryos in the lab never even progressed to a stage of development that proved that they were even alive and so were not transferred at all. Some embryos grow a little bit (or a lot) in the lab (or the uterus), then die. Period. We often don’t know why this happens but it proves that not every embryo will become a person. The idea that an embryo equals a person is just not true if you understand the biology.

4. Embryos do not become persons in a vacuum. If we don’t transfer an embryo after 5 or 6 days of culture to a receptive woman, the embryo will die. We can’t culture embryos much beyond day 6 in culture without their demise. In other words, I have yet to see a baby grown in a lab. For the best possible outcome, embryos require the very active participation of women (ideally) who want to be pregnant. It seems obvious that women, in all instances, should have a choice as to whether they stay pregnant or not, especially if they had no choice in how they got pregnant.

5. Pro-choice is not the same as pro-abortion. As far as I know, no woman is happy about having an abortion. I know women who struggled with making the choice to end a pregnancy. None of them skipped to the clinic with joy in their heart to end their pregnancy. For each one, it was probably the most difficult decision they ever made. Some of them now struggle with infertility and regret their earlier choice because they worry that the abortion procedure damaged their reproductive system. Some are grateful that they could post-pone parenthood until they were ready.

In a perfect world, only women who want to conceive would become pregnant and women who wanted to be pregnant would be able to conceive easily. We don’t live in that world. Abortion is a last resort when both plan A and B have failed.

Most of the time I blog about IVF for patients who desperately want to become (and stay) pregnant and it may seem counter-intuitive that I would support choice. But it really is two sides of the coin for me. I have written and spoken in defense of infertile women when there seems little sympathy in the wider society for infertility and infertility treatments -(Why don’t they just adopt?) – particularly if taxes might be used to support access to reproductive medicine and IVF. Some infertile patients choose to take a very difficult, expensive and medically invasive path to biological parenthood instead of adoption but it is their choice. In the US, we prize individuality and we prize our freedom. We are a diverse people with diverse beliefs. When it comes to something as fundamental as reproduction and creating a family, that diversity means one size does not fit all. Because the decision to have (or not to have) a family is SO personal and SO private, how can one set of beliefs rule us all? Protecting reproductive choice protects all women, those who want to be pregnant now and those who want to be pregnant later- when the time is right for them.

If we truly love the embryo and the potential person, we need to love the woman first because without the woman, whether the embryo is a person or not becomes a moot point.

14 Responses to this entry

You say, “many social conservatives (e.g. Representative Todd Aiken) seem to have forgotten, never learned or perhaps have willfully ignored”. And, “Some GOP conservatives think that rape is unlikely to result in pregnancy so obviously a “raped” pregnant woman is lying about her rape.” Many? Some? I’m not aware of any conservatives besides the ignorant Todd Aiken who share these views. Can you tell me who they are?

The more important question social conservatives who understand biology should be asking is why is misinformation being used to pursue a political agenda and do the ends justify the means? If you don’t like it, argue against it.

I was trying to make the point that while conservatives may be against abortion under any circumstances it is primarily for religious reasons. You would be hard pressed to find many who would aspire to the “magic vagina” theory above, or believe that raped women don’t become pregnant so a pregnant raped victim must be lying. Would it surprise anyone to find a small handful that do believe that nonsense? Of course not. Dopey outliers exist in any political party.

It Is What It Is: please don’t assume to know my political affiliation or beliefs on abortion. So far you’re not even close.

Hi Andrew,
I should have been more clear. The “magic vagina” is satire; a tool for making us re-evaluate what we hear, and I realize it is likely not the mainstream view. I also understand that conservatives have religious reasons for being against abortion. Laws that allow choice gives them that latitude. In China, the “one-child” doctrine have required women to have abortions they didn’t want. I take issue with “one size fits all” views–in either direction— that would obliterate choice based on one group’s religious (or social) doctrine. I think the issue is way more complicated–and there are circumstances in which good people can choose to have an abortion. I appreciate that you waded into the discussion. We are currently so politically polarized in the US that many of us have tuned out and turned off–and disengagement won’t lead to change that we can all live with. Thanks for being part of the discussion.

Carole, first of all, your blog is fantastic and I thank you so much for this public service.

Question: At age 39 I underwent IVF with ICSI. Eight mature eggs were produced, six fertilized, and five were still growing on day 5. I transferred two blasts on day 5 and two other blasts were eventually vitrified. From that transfer I delivered at healthy girl a few months short of age 40. Now that she is one year old I am considering an FET of the remaining blasts. Because I wanted to know if they were likely to result in a live birth, I had them thawed, biopsied, and re-vitrified. The cells were sent out for microarray genetic testing and the results were one normal embryo and one inconclusive.

Two questions:
1) Can you tell me more about the likelihood of the inconclusive embryo to result in a pregnancy and live birth? I can’t really find an estimate on the internet.

2) Regarding the normal embryo, I’ve read on some message boards that I may have damaged its chances for success by vitrifying it twice, which is terribly sad if true. Had I known this I wouldn’t have done it and would have just transferred and taken my chances, but given my age I wanted to know whether I should start cycling again. Do you think that I have likely damaged this embryo through the double freeze? I believe that the lab is very skilled and they said that the embryo did survive the thaw and biopsy.

Hi Jamie,
Thanks for your kind comments. To all my readers who think the blog is valuable, please buy my ebook for $2.99. It pays for the hosting fees that are due every month to keep the blog alive. Thanks.

Regarding your question:
1) regarding the term “inconclusive”. You should ask your PGD lab or IVF lab to explain exactly what that means. Inconclusive usually means that the test was unable to provide a reliable answer. That can be because there was a technical problem at some step or because the sample was insufficient or degraded. It may not mean that there is anything wrong with your embryo. Unfortunately, there’s probably no way to rerun the test and you certainly don’t want to thaw, rebiopsy and revitrify again.

2) There are certainly examples in the literature of babies born from egg, sperm or embryos that were thawed and refrozen and rethawed before transfer, sometimes (for embryos) even at different stages. For instance, frozen at zygote stage, thawed, cultured to blast and refrozen. Is it ideal? Probably not but embryos can be surprisingly tough. Was it worth it to biopsy and retest, rather than taking your chances with once-thawed embryos? That is a personal decision, depending on your level of comfort with uncertainty regarding whether the embryo is normal or not, how you would feel about having a child with problems (eg. Downs) and what, if anything you would do about the pregnancy.

Now you have certainty that the one embryo is normal and you can transfer it without worrying that you have transferred a chromosomally abnormal embryo. You could transfer both and do prenatal testing (CVS or amniocentesis, which is usually recommended anyway) and possible have some hard choices down the road. The embryos you produced at 39 are statistically more likely to be normal than the ones you would produce now with older eggs so I would at least try to use one of these 39 embryos, if not both. Good Luck!!!

Thank you so much for your response, Carole. I will certainly buy your e-book. Let me make additional points:

1) Yes, they could not get a definitive result. I don’t think there’s any literature on how many of these would go on to be normal; at least, none that I can find.

2) We would welcome a child with Down Syndrome and would not terminate, thus I would not have amnio. When I made the decision to thaw and biopsy I was trying to decide if I had to stop breast feeding and transfer immediately in case the embryos were so chromosomally abnormal that there was no chance of a live birth. I knew that if that were the case I would have to start cycling again. I am acutely aware of my age and knew that time was not on my side.

I would have never done this had my RE mentioned to me that there were any possible ill effects to the embryo by this process, but he did not. It makes me ill to think that I could have ruined a perfectly good embryo. It sounds as if the thing to do is transfer as soon as I feasibly can to see if it takes. I was hoping to let my daughter get a bit older and transfer next February, but that may not be the best plan in case the transfer doesn’t work and I have to cycle again.

Hi Jamie,
Because women have a relatively short reproductive “life span” vs our rather long biological life span, we are often faced with difficult decisions. I wish I had and easy answer for you but there isn’t one. Both options (FET now and fresh cycle later or vice versa) may result in pregnancy but neither option is guaranteed to work. Either choice would have you give up nursing early. For myself, I wouldn’t want to miss any nursing time with the child I already have for the theoretical child I might have. But I tend to be rather risk adverse and I had to give up nursing early with my children for work reasons which made me feel a little cheated when I was a new mother. My kids turned out fine –it didn’t harm them at all!– but it made me feel bad at the time. But my choices are not yours and persons have equally valid reasons for opposite choices. In any case, I feel that you will come to the decision that is best for you and your family. Wishing you all the best and much Good Luck. Carole

Hi Carole, thanks. The biopsy was actually done back in February when my daughter was ten months; I was trying to buy a little more time with her before another pregnancy. Hearing that the one embryo was normal made me feel more comfortable waiting to transfer until next February. I am praying that it takes and we get a sibling; if not, I’ll be cycling again with CGH testing on all fresh embryos. Thank you again for your thoughts; I have purchased your e-book and look forward to reading it! 🙂

I think its very helpful that your offering a reproductive biology lesson for the politically active.

I am pro choice and do not believe that eggs, sperm or embryos should qualify as people deserving of the same rights as people who are actually born.

Eggs and sperm and embryos are not people, donors of those things donate them and then sign agreeing to provide two additional services 1) they agree to reproduce, and 2) they agree to relinquish their parental rights to any children born of their reproduction from their donated genetic material. It is all spelled out in great detail in their agreements that say things like their offspring born of the donated material will morally and contractually belong to the recipient and the donor agrees to waive any and all parental rights to said children in the event that any are born etc etc. It is important not to pigeon hole people who believe that donors are donating their children and their parental rights as religious extreemists who believe that life starts before birth. In all fairness the agreements donors sign require them to give up any children born upon their birth if any are born. Its just a service offered later for payment now. Like agreeing to a share of box office proceeds if a movie grosses over a certain amount. If and when a child is born the donor agrees to give up parental rights. Its not far fetched there is an entire boutique legal industry predicated upon contract righting that ensures donors don’t sue for visitation or custody. If they refused to give up parental rights nobody would want their genes that are not people, right?

I have 2 technical questions
1) Why with all the genetic testing donors go through these days to prevent unhealthy births is there not mandatory genetic testing against the recipient to ensure that the donor and the person he or she will be reproducing with are not any closer related than say, 2nd or 3rd cousins? Seems like a huge risk reproducing with an anonymous person who is likely from the region where you live. There is some risk regardless of where the donor and the person reproducing live.

2) There are many egg donor recipients who believe that they are reproducing with their partners when that is not true they don’t reproduce even though they gestate. I’ve read some recipients say that they are the biological mothers of the children they deliver because they believe their biology supported the fetus. But women are not mothers during pregnancy, they are expectant mothers. Once the baby is born if the woman is not the biological source of the person she delivered, yet someone else is it means the child is the biological offspring of the other woman and she is the bio mother.The period of time when their biology came in contact was prior to the time when the carrier qualified for the title of mother legally based upon birth. Also many think they share blood with the fetus and that their cells reproduce and the donor donates dna only. Can you clear that up?

Hi Marilyn,
In answer to your questions:
1). Traditionally, Egg Donors do not have extensive genetic testing. They have extensive testing for communicable diseases (HIV, HTLV, Hep B &C, CMV, Syphilis, gonorrhea etc). They undergo genetic screening in that they are asked to supply a three-generation medical history which asks about genetic and other disease histories. This is different than genetic testing– genetic sequencing of DNA. Increasingly, sperm banks are adding more true genetic testing. For sperm donors, the largest cryobanks have started to provide a laundry list of genetic diseases tests on their donors. See more at this link: http://www.cryobank.com/Services/Genetic-Counseling/Donor-Screening/#answer07 For instance, at California cryobank, this is their screening process for sperm donors http://www.cryobank.com/How-It-Works/Donor-Qualification/ In contrast, many egg donation programs are run in-house by the IVF program and these smaller operations tend not to be able to front the cost of extensive genetic testing so the medical history questionnaire is used instead.

It seems that your concern about genetic testing is primarily to avoid consanguinity. ASRM addresses that concern by issuing professional guidelines for the use of donors which are designed to minimize–the already low risk of consanguinity (close relatives having children together) — by recommending that donors be stopped from further donation when they have a maximum of 15 offspring per 500,000 population. Some donor programs have even stricter program rules regarding donation to half that many offspring per 800,000 population to reduce the risk even further.

2) A gestational surrogate carries the embryo created by another couple and is not the genetic mother. In the same way, an unrelated recipient (meaning the egg donor and recipient aren’t related) from an egg donation scenario also has no genetic link to the child. If the egg donor is sister or niece or cousin to the recipient, obviously there is some relatedness. The placenta has a blood barrier that selectively admits an exchange of nutrients and waste products between the blood supply of the fetus and the blood supply of the woman carrying the child. These deep connection does not create a genetic link but obviously can create a biological and an emotional link. The laws regarding parentage are based on three possible things; the genetic link (eg. paternity testing), who gave birth to the child (why in some states intended parents must legally adopt their genetic child) or in the case of paternity, the man married to the woman who gave birth is legally the father of the child whether or not he is the genetic father. Obviously, these criteria which are not even consistent state to state are each problematic because of the new options for parenthood created by IVF.

I think that rather than focusing on reasons why women are NOT to be called mothers, we should instead focus on ways we can all better “mother” the children in our care, whether we are genetic mothers, biological mothers, nurturing mothers or all three at once.

First – that is so exciting you had your IVF cnsluot. You are moving forward and that is awesome! Second, i dont think it’s a big deal to be on BCPs for long – most women on medicated cycles are & having ER on 12/25 is just not ideal! Third, every thing i have heard from PGD is that it’s worth it. We would have done it but it’s an extra $6,000 and we decided not to. As far as pharmacies, there are some online ones that offer discounts but we ended up using a local one b/c it was cheaper and easier to control when i picked up drugs. One piece of advice i learned: Don’t buy ALL the drugs in one fell swoop – by them as you go. it’s more to manage but REs always order more than you’ll need and if you are OOP you’ll end buying drugs you won’t even use. I paced my purchases every few days and didn’t have any extra – saved myself over $1,000. GL! I’m excited for you!

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Fertility Lab Insider

Lessons learned from over fifteen years of working inside fertility labs.